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Uneven pupil dilation2/28/2023 That injury to her artery caused a stroke. The carotid artery on the right side of her neck, the blood vessel that brings blood from the heart to the brain, had been injured, in what is called a spontaneous carotid-artery dissection (SCAD). The relief was so great she almost missed what the doctor said next. The voice on the line explained that the mass wasn’t a brain tumor. They were finishing their meal when another call came in. was noisy, and she held herself as still as she could so the pictures would be clear enough to explain what was seen on the CT. A mass in her brain, she told her husband. It was only after she hung up the phone that she was able to process what she’d heard. Could she come in the next day for an M.R.I.? On autopilot, she made the arrangements for the follow-up scan. There was a mass in her brain, the doctor said, her voice warm and sympathetic. Late the next morning, in the car, now a state away, she got a call. It was odd but went away after a few hours. So was a small patch of her face, near the left side of her mouth. That evening she noticed that two fingers on her left hand were numb and tingly. The next morning they planned to drive to Chicago to visit friends and family. It was the kind of hard physical work that she enjoyed. She spent the afternoon at the butcher shop, hauling pieces of meat and packing them up for delivery. Afterward, she went to do work for the community agriculture program she ran. She recommended a different medication for the migraine and ordered the CT scan. Still, it hadn’t been there the day before. Could the order be altered? That kind of difference in the size of the pupil - a phenomenon known as anisocoria - could be seen in people with migraines, the doctor told the anxious woman. if anything changed, and Cho suggested a CT scan now. The patient pointed out the difference in her eyes. He was tied up, but she saw another doctor. Kaufmann’s office was located in Emory University Hospital Midtown, so she went there first. “I think you should go to the emergency room. Her right eye was mostly the green hazel of her iris, the pupil small, as if that half of her was in a different room, with a bright light. Sure enough, on the left, her eye was mostly dark pupil, dilated in the soft light of the room. Her pediatrician friend asked, as casually as she could, if the woman noticed that her pupils were different sizes. It didn’t really do the job, but it was better than nothing. Instead, she told Cho, she just took more ibuprofen. She didn’t even pick it up from the pharmacy. She read up on the medication he prescribed. It didn’t feel at all like her migraines. If her headache didn’t go away or if anything changed, she should get an M.R.I. He gave her a prescription for a painkiller. His logic was straightforward: A headache in someone with a history of migraines is probably a migraine. When she said it didn’t feel like her usual migraines, he pointed out that migraines don’t always feel the same. When he heard about her headache, he immediately thought it was a migraine. She didn’t see him often, because she was hardly ever sick. Robert Kaufmann had been her primary-care physician since her old doctor left Atlanta a decade ago. Her friends had insisted she see her doctor. Sometimes it was a little better, sometimes a little worse, but it was always there. It was right here, she pointed to a place near her temple, on the right side of her face. But she was left with a different kind of headache. After a couple of hours and probably too many ibuprofen, the migraine faded away. A spot of static appeared in the middle of her vision, and she felt the sharp stabbing head pain that sometimes accompanied her migraines. It started out like one of her migraines. She had a history of migraines, brutal but rare headaches that made her retreat to a dark room. It was a headache that she just couldn’t shake. She hadn’t been feeling well, the baby’s mother told Cho. The baby seemed to be thriving, but the doctor was concerned about her friend. Cho is a pediatrician her friend had brought her 8-month-old baby in for a checkup. Cornelia Cho said to her old friend as she examined the friend’s baby boy.
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